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SB 330

Department of Health rule relating to critical access hospitals

2025 Regular Session Introduced by Jack Woodrum

Requires quarterly public reporting by LME/MCOs on access metrics and enforces minimally adequate service standards to improve access and reduce emergency department boarding.

Reported in Com. Sub. for S. B. 325
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Bill Summary · SB 330

SB 330 — LME/MCO Transparency and Accountability

Status: Introduced / Passed 1st Reading (Mar 19, 2025); referred to Rules and Operations of the Senate (NC)

Main purpose

Require quarterly public reporting by Local Management Entities / Managed Care Organizations (LME/MCOs) on access to behavioral health providers and create clear, measurable “minimally adequate” service standards for LME/MCO performance. The bill is intended to increase transparency, measure network adequacy, reduce emergency department boarding, and give the Department of Health and Human Services (DHHS) enforcement tools when LME/MCOs fail to meet access benchmarks.

Key provisions

  • Quarterly reporting (beginning Oct 1, 2025, and continuing for four years) — each LME/MCO must submit to DHHS:
    • The number of individuals served with emergency department (ED) stays > 24 hours, with length of stay for each.
    • The number and percentage of individuals who could not access a provider willing and able to begin approved services within 30 days.
    • Dollars retained by the LME/MCO because approved services were not used due to lack of available providers.
    • Initial count (and quarterly changes) of in‑network providers by provider type.
    • The number of individuals deemed eligible under contract but who are not receiving any or all contracted mental/behavioral/substance‑use services (unless another payer is providing the needed service).
  • Minimally adequate services standards (Secretary of DHHS to adopt rules):
    • ED boarding: fewer than two beneficiaries per county in the LME/MCO catchment area may be “boarded” in a hospital ED at any one time. “Boarded” = ED stay > 24 hours after medically cleared for discharge/referral.
    • Timely initiation: at least 85% of the time, individuals must begin receiving all approved services within 45 days of approval (excludes certain specialized medical services with long waits for non‑Medicaid beneficiaries).
  • Enforcement and contracting:
    • Secretary may include these criteria in managed‑care contracts and develop additional access measures.
    • Failure to meet benchmarks (as adopted in rules) for two consecutive quarters constitutes failure to provide minimally adequate services and triggers corrective action by the Secretary.

Who is affected

  • LME/MCOs operating behavioral health managed‑care networks (reporting and potential corrective actions).
  • Medicaid and publicly funded behavioral‑health beneficiaries (goal: improved access and reduced ED boarding).
  • DHHS (data receipt/analysis, rulemaking, enforcement).
  • Providers and hospitals (implications for network capacity, referrals, and ED throughput).

Procedural / timeline highlights

  • Reporting requirement: quarterly starting Oct 1, 2025 for four years.
  • Secretary must adopt rules to implement the minimally adequate standards (bill text sets an implementation target date but contains an apparent drafting date irregularity — the standard language in the draft references Dec 31, 2023; stakeholders should confirm the final rule deadline in the enacted language).
  • The bill becomes effective when enacted into law.

Potential impacts and considerations

  • Intended benefits: better public visibility into access problems, earlier detection of capacity shortfalls, reduced ED boarding, and stronger contractual leverage for DHHS.
  • Administrative costs: compliance burden for LME/MCOs and DHHS (data collection, reporting and analysis); potential need to expand provider networks or procure services to meet access targets.
  • Data quality and privacy: implementation will require secure, standardized reporting formats and protections for patient privacy.
  • Enforcement: corrective actions unspecified in detail — may include remediation plans, sanctions, or contract remedies.

For exact rulemaking deadlines, enforcement details, and any final technical edits, consult the version of SB 330 as enacted (or the DHHS rulemaking notices following enactment).

Compiled from official sources — confirm details with the bill’s official record.

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